Question Easy:
A 35-year-old woman presents with dysuria, increased urinary frequency, and suprapubic pain. You suspect acute cystitis. What is the recommended initial management?
A) Nitrofurantoin
B) Ciprofloxacin
C) Amoxicillin
D) Metronidazole
E) Trimethoprim
Explanations & Answers:
Question Easy Answer: A) Nitrofurantoin
Question Easy Explanation: According to NICE guidelines, nitrofurantoin is the first-line antibiotic for uncomplicated urinary tract infections (UTI) in women, provided there are no contraindications.
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Question Medium:
A 64-year-old man with type 2 diabetes presents with fatigue, increased thirst, and nocturia. His blood pressure is 160/100 mmHg. His serum creatinine is 2.0 mg/dL, and his estimated glomerular filtration rate (eGFR) is 45 mL/min/1.73m². What is the most appropriate management to protect his renal function?
A) Increase fluid intake
B) Prescribe an ACE inhibitor
C) Advise bed rest
D) Prescribe a diuretic
E) Decrease protein intake
Explanations & Answers:
Question Medium Answer: B) Prescribe an ACE inhibitor
Question Medium Explanation: For patients with diabetes and hypertension, NICE guidelines recommend the use of an ACE inhibitor to help protect renal function and reduce blood pressure. ACE inhibitors have been shown to reduce the progression of diabetic nephropathy.
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Question Hard:
A 50-year-old patient with a history of kidney stones presents with sudden severe, colicky flank pain radiating to the groin. He is afebrile, and urinalysis shows microscopic hematuria but no signs of infection. What is the next most appropriate step in management?
A) Intravenous fluids
B) Abdominal ultrasound
C) Non-contrast CT scan of the abdomen and pelvis
D) Plain abdominal X-ray
E) Magnetic resonance imaging (MRI)
Explanations & Answers:
Question Hard Answer: C) Non-contrast CT scan of the abdomen and pelvis
Question Hard Explanation: The gold standard for diagnosing kidney stones is a non-contrast CT scan of the abdomen and pelvis. This imaging modality is preferred due to its high sensitivity and specificity for detecting stones, as recommended by NICE guidelines.
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Medical fact of the day: The glomerular filtration rate (GFR) is often estimated using creatinine-based formulas such as the CKD-EPI equation. GFR is a critical measure in diagnosing and monitoring kidney disease.
Quote of the day: “In the realm of medicine, remember that every challenge faced is an opportunity to save a life and make a difference. Stay resilient and compassionate.”